Incrementalism in Policy Making


The healthcare industry is a delicate one as it deals with human life, which is unique and subtle. Ensuring that the American citizens receive adequate and quality healthcare services is the responsibility of the governments, which they have strived to ensure they are insured. Healthcare insurance is essential as it ensures that all people can access healthcare services efficiently, with high quality results, and affordability (USHPG, 2019). However, the journey to ensure all Americans are covered and can afford quality healthcare has not been easy due to policy ineffectiveness, system failures, and healthcare disparities. The following is a discussion of the ACA program highlighting its impact, successes, failures, and possible policy changes for future effectiveness and efficiency.

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An Evaluation of the Impact of ACA on the Uninsured Population

The ACA plays a vital role in the healthcare sector as it ensures that the American population has access to quality healthcare services through the aspect that it provides health insurance coverage. The entire population in the USA is not insured; however, over the years, the number of uninsured people has reduced to 17.8%, approximately 42 million Americans. Population groups that mainly remain uninsured include low-income families with higher FPL index of 400% and people of color (KFF, 2018). The reasons for staying uninsured vary and depend on the individuals; however, the highest percentage indicate high costs of coverage as the primary reason. Other causes include lack of employment, ineligibility factors, and immigrants without legal documents.

The ACA has had and will continue having a significant impact on the uninsured population for various reasons. These impacts are both positive and negative. Some of the positive impacts include an increase in the insured people as well as increased gains that have decreased medical bills. The government has had a detailed assessment of the uninsured population and their enrollment into the ACA insurance. According to the data acquired from the survey, 20.85 million people have newly enrolled for the Aca insurance and gain its benefits. The reason for this large enrollment is due to the state’s expansion of Medicaid and exchange enrollments. The enrolment increased and kept increasing even in the private sectors and increased employer-related health insurance covers. The ACA has expanded its eligibility, and the private insurers keep flooding the market, thus providing diverse options to choose form. Concisely, the ACA has affected the insurance coverage, as there has been an increase in the individual market enrollment, thus reducing the uninsured population.

On the other hand, the repeal of the ACA program has resulted in reducing the insured employer plan enrollment, as many employees have lost their employment or insurance covers. According to the survey, about 20 million people have negatively been impacted, as they have lost their employment and healthcare insurance covers amounting to 4 million people (USHPG, 2019). Approximately 13 to 14 million Americans are and will likely be affected by the repeal of ACA negatively, which calls for assistance and effective policies.

Success and Failures of the ACA

The ACA has been successful on many occasions since its inception. The initial success is the ability to bring affordable healthcare to the USA. The ACA has improved the healthcare and financial security among Americans, expanded healthcare among over 20 million people, increased private coverage, and has reduced healthcare disparities. Primarily, the ACA has enabled secure access to healthcare services through its benefits. According to the HHS, over 20 million people are estimated to be insured and an addition of 24 million people with access to subsidizes (USHPG, 2019). The 44 million is a number close to its target population of 47 million Americans. Many people keep signing up for the coverage through the state or federal health sponsored insurance exchanges and through other private insurers. The program has ensured the population accesses healthcare services even among low-income households, meaning that it wants its people to acquire affordable and quality healthcare. Low-income households with up to 400% FDL index can comfortably access the ACA program.

Secondly, ACA has improved healthcare access and financial security among many people. An individual without any healthcare insurance coverage is likely to have massive bills that may be difficult to pay. They may skip some tests because they are expensive, and may even refuse to visit healthcare providers due to lack of adequate finances. All these instances, especially inability to pay huge medical bills can be detrimental in a person’s financial life (USHPG, 2019). They can deplete all their life savings and investments trying to settle medical bills. However, though the ACA program, even low-income households, can acquire quality and full healthcare treatment without passing on any necessary tests. This has resulted in improved health outcomes, promoted economic stability, and reduced any uncompensated care.

Every program has a share of its successes and failures, and ACAA program is no exception. The program has fallen short on many occasions, including on its original goals. In addition, the program remains expensive, as a substantial number of people are uninsured; it is complex and confusing to many. Primarily, the program has fallen short in its initial goals in that, during its inception in 2010, the CBO projected that the ACA would cover 32 million out of the 47 million uninsured Americans by 2019 (KFF, 2018). However, in 2019, only 20 million are estimated to be insured and an addition of 24 million people with access to subsidizes. This equals only 44 million Americans, which does not attain the 47 million target.

Secondly, although the ACA provides affordable and easy access to healthcare services, a substantial number of Americans remain uninsured. Population groups that mainly remain uninsured include low-income families with higher FPL index of 400% and people of color (KFF, 2018). The reasons for staying uninsured vary and depend on the individuals; however, the highest percentage indicate high costs of coverage as the primary reason. They feel that the program is expensive and unaffordable. Besides, the program has many weaknesses, as there are many political debates over its effectiveness in the future. Moreover, it has harmed the Americans as some have lost their insurance coverages and employments.

Implications of the Success and Failures of the ACA

As stated above, the ACA program has both successes and failures ever since 2010 when it was enacted. These successes and failures result in both positive and negative impacts on stakeholders such as insurers, governments, and Americans. In most cases, the limitations and failures of the ACA program have outweighed its successes. It is for this reason that the program has and is undergoing many policy changes, recommendations to replace it, and even political debates to repeal it without any replacements (USHPG, 2019). The policymakers responsible for the development and success of the ACA program must initiate many policy changes concerning the program’s costs, access, and affordability. It should have the ability to meet its goals and withstand political and economic pressures.

The ACA program paints both a good and bad image of the government. This is because the program covers over 40 million people, meaning that the government is fulfilling its mandate as expected by the citizens. However, when 13-14 million people are negatively affected by the same program, which has become a political matter, it reflects negatively on the government’s duty and mandate. The funding of the program is another source of negative impact. The costs of funding this program are felt at the federal, state, and individual levels. Some of the uninsured people claim the program is expensive to acquire; thus, they remain uninsured. This has affected the enrollment numbers, which continue reducing annually, hence an increase in uninsured people and altering with those with health insurance coverage already (USHPG, 2019). In the future, the ACA program will have a significant influence on the costs of care and access as well. Besides, it is due to the act that there is a 21% tax increase from high-income taxpayers, penalty payments, health industry taxes, and other taxes to cater for the costs burdens of sustaining the program.

Changes in the ACA for Increased Efficiency

When evaluating the act’s successes and failures, it is clear that the failures outweigh its accomplishments. The ACA acts as a vital provision to enable the governments’ mandate to provide affordable access to healthcare. Therefore, repealing it would be drastic as the number of the insured Americans would drop drastically, which is not the most effective solution. Replacing the act with another plan would be an option; however, no system or program is purely accurate without any flaws (USHPG, 2019). It is likely to be faced with challenges just as the ACA is facing and would take very long before it is implemented and picks up effectively. Making changes in the ACA program would be the most effective recommendation, less costly, and timesaving.  

Various changes can be made on the program to increase its effectiveness and efficiency. They include modifications on the Individual Mandate penalty, the ACA Plans, the premiums, and the premium tax credits. Primarily, the Individual Mandate penalty is a provision that should be repealed, as is the case as from 2020. The provision has been unpopular, criticized, and challenged by many people being termed intrusive and burdensome. Secondly, the current ACA plans available include bronze, silver, gold, and platinum, which have not changed for a long time. The offers and benefits in each plan vary depending on the costs and levels. For instance, platinum has the highest and comprehensive benefits and the most expensive, while bronze has the least. The silver plan has adjustable premiums, but no many can access (KFF, 2018). The highest number of low-income individuals pay for bronze. The benefits are least, and these people are subject to chronic diseases. The plans should be adjusted to at least balance the benefits, which will reduce disparities and constraints.

Thirdly, premium tax credits are essential as they increase the affordability levels of insurance coverage among low and middle-income individuals. However, it requires significant revisions, especially in the formula used for determining tax credits in the market places. Typically, one contributes a maximum amount to their premiums depending on their income, and the exceeding amount is refunded as tax credits (USHPG, 2019). The changes in this formula include adopting a sustainable and advanced model, which would separate premiums from the tax credits. Proposals given in regards to this change include AHCA, the flat-rate tax credit, and age-adjusted tax credit. Moreover, the credit amount is unavailable for individuals that qualify for Medicaid and CHIP, which should change to increase eligibility.


The future of healthcare depends on the aggressiveness and committed seen among governmental, private agencies, and citizens. Existing policies such as the ACA, Individual Mandate, Medicaid, and Medicare are provisions used by the government to increase enrollment and acquisition of healthcare insurance covers. They are crucial, as they have had substantial positive impacts on maximizing affordable and access to healthcare services. However, policy changes, politicizing the health acts, and changing demands in the market place and healthcare needs have rendered them insufficient. They have not addressed healthcare disparities adequately, but they have enabled a step ahead to fully addressing the issues. These policies should be revised or replaced to accommodate the changes in the marketplace or repealing some of them that are insufficient.


KFF. (2018, December 7). Key Facts about the Uninsured Population. Retrieved from

USHPG. (2019, January 1). ACA Impact Analysis. Retrieved from U.S. Health Policy Gateway:

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